Form 1 Class Request Form

CLASS Course Request Form

OMB# 0925-0753

Expiration Date: 05/31/2024

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to:

NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974,

Bethesda, MD 20892-7974, ATTN: PRA (0925-0753). Do not return the completed form to this address.

Instructions: Submit the completed form to CLASSHelpDesk@westat.com. Please contact the CLASS team for any questions regarding the form. All questions marked with a red asterisk (*) must be completed.

	SECTION I – Course Request Information
1.1*		Name of Person Submitting Form
1.2*		Email of Person Submitting Form
1.3*		Course Title:
1.4		Course Description:
1.5		Thumbnail Image?	Yes ☐ No ☐ (If Yes, then for best resolution provide a 229 x 173px attachment)
1.6*		Training Content Format (e.g., SCORM, video, etc.)
1.7		Unique Course Tags/Key words/Folder?	Yes ☐ No ☐ If yes, then provide here:
1.8*		New or Replacement Course/Process?	New Course ☐ Replacement ☐ If replacement, then provide effective or cutoff date:
SECTION II – Course Setup
2.1*		Course Availability Rules Who should be enrolled in the course, e.g., based on role, study approval, other? Are there any restrictions to this?	Self-Enrollment ☐ Auto-Enrollment ☐ Other ☐ Explanation:
2.2*		Is this Training Associated with a Protocol Specific Requirement (PSR)? Implies the training is required for site registration approval or other requirement, e.g., ability to be selected in OPEN.	Yes ☐ No ☐ If yes, indicate which protocol and type of PSR.
2.3*		Does this Training Control Access to a System/Application?	Yes ☐ No ☐ If yes, indicate which system:
2.4*		Is this Training Associated with a Task on a Delegation of Tasks Log(s) (DTL) Template?	Yes ☐ No ☐ If yes, indicate which protocol and task:
2.5		Is There a Due Date? Sets a "soft" expectation that the learner will complete the course by the date/timeframe entered. When the due date passes, the course is still available to the learner to take and complete.	Yes ☐ No ☐ If yes, provide date or timeframe (e.g., 60 days from enrollment).
2.6		Is There an Expiration? Sets a date beyond which the course will no longer be available to the learner.	Yes ☐ No ☐ If yes, provide date or timeframe (e.g., 60 days from enrollment).
2.7*		Prerequisite Required? Learners will be allowed to enroll in the course but will be unable to take it until all prerequisite courses are completed.	Yes ☐ No ☐ If yes, provide course(s) that must be completed first.
2.8		Allow Video Seeking? Seeking allows learners watching a video to move around within the timeline of the video.	Always allow seeking ☐ Allow seeking only after learner has completed the lesson (i.e., for subsequent viewings of the video) [default] ☐
2.9		Resource Documentation Attachments? Materials that are to be posted in the course’s Resources section but are not officially part of the course.	Yes ☐ No ☐
SECTION III – Course Completion
3.1		Completion Certificate?	Default is Yes for all courses. Standard ☐ Custom ☐ (If custom, provide as PDF attachment).
3.2		Attestation for Completion?	Yes ☐ No ☐ If Yes, then provide attestation wording here:
3.3		Is There a Quiz?	Yes ☐ No ☐ If Yes, then provide quiz questions and answers here or as attachment.
3.4		Can Learners Fail the Course?	Yes ☐ No ☐ If Yes, then can learners retake the course? Yes ☐ No ☐ Additional details:
SECTION IV – Emails
4.1		Custom Email Message? Can be sent at assignment, at completion, or as reminders.	Yes ☐ No ☐ If yes, then provide custom email message here or as an attachment:
4.2		Nudge Emails? These are reminder emails sent if a course is not completed.	Yes ☐ No ☐ If yes, indicate frequency and number (e.g., weekly for three weeks):
4.3		Automated Reporting? The CTSU can program course activity reports to be generated automatically and sent via email.	Yes ☐ No ☐ If yes, then: Daily ☐ Weekly ☐ Semi-monthly ☐ Monthly ☐ Email address for user(s) receiving report:

December_2023

Authorized by CTSU for local reproduction